Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



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10:27 AM
August 2nd, 2018

Seasonal Flu

What Is Flu?

Influenza, or “flu,” is a highly contagious respiratory illness that occurs in seasonal epidemics.  An episode of flu typically runs its course over several days.  Although usually just a severe nuisance, flu can sometimes result in respiratory failure and death.

 

Symptoms

An attack of influenza is usually accompanied by muscle aches, headache, fever, sore throat, red watery eyes, runny nose, and cough.  Only some of the symptoms may be present.

 

These symptoms sound like a cold, and like a cold, flu is a respiratory infection. However, influenza is caused by a different virus and is more severe.

 

Severity

Each year about 200,000 Americans are hospitalized because of flu complications. The number of deaths varies depending on the annual virus strain; but American deaths have recently ranged from 3,000 to 49,000 in a year.  While human lives are most important, it is noteworthy that even mild strains of the flu can impact the American economy by $10 billion annually in lost productivity.

 

Contagion

Influenza is typically spread by the aerosol droplets propelled in the course of a cough or sneeze.  Even people six feet from a sneeze are at increased risk of infection from these micro particles.  

 

Flu can also be spread from surfaces.  If a person coughs into their hand or sneezes into a handkerchief and then touches an object such as a doorknob or computer keyboard, that object becomes contaminated. A person who touches the object shortly afterward can be infected, usually when they transfer the virus from their hand to a mucous membrane such as the nose, mouth, or eye.

 

Because of the high level of contagion, it is important that flu patients remain home to avoid infecting co-workers.

 

Infectivity

Once a person becomes infected by the virus, it takes 1 to 4 days before they exhibit symptoms.  However, they may transmit the virus to others even before symptoms become evident. Thus it is not sufficient to avoid persons who appear to be sick.  It is important to make a habit of frequent hand washing as this can reduce both virus dissemination and acquisition.

 

Complications

Occasionally influenza does not run its normally uneventful course but instead results in complications.  Some of the most serious of these are viral pneumonia, bacterial pneumonia, respiratory failure, an inflammation of the heart (myocarditis), an inflammation of the membrane surrounding the heart (pericarditis), and multiorgan failure.

 

Vulnerability

Fatalities are most common in infants and the elderly. Thus it is important that senior citizens receive vaccination, the “flu shot.”  Vaccination is also important for pregnant women.  Pregnant females are not at risk from the flu shot and they need vaccination because they are at increased risk of complications from flu and they need to pass on their immunity to the newborn.

Others who are at increased vulnerability are those who are immunocompromised from disease or chemotherapy.

 

Pandemics

A pandemic is an epidemic that occurs over a broad area.  Four flu pandemics have occurred in the last century.  These epidemics occurred when a highly contagious and aggressive strain of the virus emerged.  

 

The infamous “Spanish flu” of 1918 killed nearly 675,000 people in the US and a possible 50 million people worldwide.  

 

The “Asian flu” of 1957 killed about 69,800 people in the US.  

 

The “Hong Kong flu” of 1968 took the lives of 33,800 people in the US.  The relatively modest number may have been largely due to the availability of antibiotics to treat secondary bacterial infections.  

 

The “swine flu” of 2009 caused between 9,000 and 18,000 deaths.  The reduced number of deaths in this epidemic may have been due to the fact that 80 million people were vaccinated.

 

Flu Vaccination Does Not Cause Flu

Vaccination against flu can be by injection or nasal spray.  The injection contains virus that is inactivated (“killed”). The nasal spray contains virus that is attenuated (“weakened”) and so altered that it can be active only at the cooler temperatures of the nose and not in the warmer temperatures of the lungs. The result is that flu vaccination does not cause the flu!

 

Vaccination Side Effects

Serious vaccination side effects are quite rare.  They are circumvented by avoiding certain flu vaccinations in specific groups of people.

 

Traditionally, flu vaccine was produced using chicken eggs and was contraindicated in persons with egg allergy.  Since 2012 a vaccine prepared in a different manner has been available for persons 18 years of age and older who are allergic to eggs.

 

An inactivated virus vaccination rather than an attenuated virus vaccination is generally appropriate for persons with weakened immune systems congenitally, from illness, or from chemotherapy.

 

In short, some type of flu vaccination should be appropriate for most individuals 6 months of age and older.

 

So If I Get Vaccinated, I Can’t Get the Flu, Right?

Not quite!  In the recent past flu vaccination has had 70% effectiveness against influenza B and 60% effectiveness against influenza A.  This is so because:

  • The US Center for Disease Control (CDC) must project in advance the virus strains of the upcoming flu season.
  • Different individuals have different capabilities of manufacturing antibodies in response to the stimulus of the vaccine.
  • It takes 1-4 days after infection for flu symptoms to emerge.  Persons can be infected before they receive the vaccination.
  • It requires 7-14 days for the body to build antibodies from the stimulus of the vaccination. Vaccinated people can be infected with flu during this time period.
  • Symptoms of flu can be simulated by other virus infections.  Flu vaccinated persons who seem to get the flu may have these other infections.

 

How Can I Prevent the Flu?

The best method of dealing with the flu is not to have it!  In order to greatly reduce chances of getting the flu, it is most important to take these precautions:

  • Practice frequent hand washing, especially after contact with objects touched by infected persons or the general public.
  • Avoid proximity to infected persons.
  • If infected, stay home and avoid contact with others. Bear in mind that you are infectious for 4-9 days after onset of symptoms.
  • Finally, present yourself for vaccination.  This is your surest way of protecting yourself from flu.  As an added benefit, remember that by getting vaccinated, you are also protecting newborns, elderly, chemotherapy patients, and others unable to fully benefit from their own vaccination.

 

Conclusion

So please stay well this season and protect yourself from flu.

 

Thomas Falasca, DO

View this fact-filled video on flu symptoms from the US Centers for Disease Control!

 

Breast Cancer Awareness

About 1 in 8 U.S. women will develop invasive breast cancer over the course of her lifetime.

 

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Breast Cancer Awareness

Prevalence

 

About 1 in 8 U.S. women will develop invasive breast cancer over the course of her lifetime. Breast cancer accounts for 29% of all cancers in women; it is second only to lung cancer as a cause of cancer death among women.

 

In 2018, an estimated 266,000 new cases of invasive breast cancer are expected to be diagnosed in US women in the U.S., along with 63,960 new cases of non-invasive (in situ) breast cancer.

 

Although the overall US incidence of breast cancer is higher in white women, a larger proportion of African-American women are diagnosed with larger, advanced-stage tumors. In 2015, breast cancer death rates were 39% higher in African-American women than in white women.

 

Risk Factors

 

Increased age is a predominant risk factor in breast cancer. The disease is 7 times more likely in women over 50 than in those under 50. Nevertheless, when breast cancer occurs in younger women, it tends to behave more aggressively.

 

The incidence rate of breast cancer increases with age, from 1.5 cases per 100,000 in women 20-24 years of age to a peak of 421.3 cases per 100,000 in women 75-79 years of age

 

Family history is a further risk factor. The risk is 5 times greater in women who have two or more first-degree relatives with breast cancer. The risk is even greater if the relative was less than 50 years old when diagnosed with breast cancer. Further, ovarian cancer is also a consideration. Ovarian cancer in a first-degree relative doubles the risk of breast cancer.

 

Current oral contraceptive use seems to increase the risk of breast cancer by about 25%. To put this in perspective, it means that a hypothetical risk would rise from 20 in 10,000 to 25 in 10,000. However, risk returns to that of the average population within about 10 years following cessation of oral contraceptive use.

 

Increased risk of breast cancer in postmenopausal women has been associated with the following:

     Adult weight gain of 45 pounds above body weight at age  

     Diet high in animal fats and refined carbohydrates

     Sedentary lifestyle

     Consumption of 3-5 alcoholic beverages per week

 

Finally, increased risk of breast cancer has been associated with first pregnancy at a later age, early onset of menses, and late age of menopause.

 

On the brighter side, close adherence to a Mediterranean diet is associated with lower risk for breast cancer, especially for types that carry a poorer prognosis in postmenopausal women.

 

Types

 

Contrary to popular belief, breast cancer is not a single entity. There are almost a dozen different types of breast cancer. Two of these, infiltrating ductal carcinoma and infiltrating lobular carcinoma, account for almost 90% of cases. The different types of breast cancer are typically identified when the pathologist views the tissue specimens under a microscope. Some types behave much more aggressively than others.

 

Even within these types, there are certain characteristics that can make some cases behave differently from others. These individual characteristics may make some tumors more susceptible than others to certain treatments.

 

Signs and symptoms

 

Early breast cancers usually have no symptoms. Later breast cancers may show

     Change in breast size or shape

     Recent nipple inversion or skin change, including nipple abnormalities

     Skin dimpling

     Nipple discharge, especially if blood-stained

     Lump in the armpit 

 

Only 5% of patients first consult their doctor because of breast pain or discomfort.

 

Screening

 

Because of the absence of early signs and symptoms, screening plays an important role in early detection. Some evidence exists that, at 14 years follow-up, screening mammography reduces breast cancer deaths by about 20–35% in women 50–69 years old and slightly less in women 40–49 years old.

 

Mammography often detects a lesion 1 to 2 years before noted by breast self-examination. Nevertheless, partly due to lack of health insurance, 20-30% of women still do not undergo screening as indicated.

 

Debate continues among authorities regarding the appropriate interval between mammographic screenings, the age at which screenings should begin, and the age at which they are no longer necessary. However, there seems to be general agreement that annual mammography is more appropriate to younger women, that biennial mammography is more appropriate to slightly older women, and that screening mammography is not appropriate for women with a limited life expectancy. For specifics about ages and frequency intervals, each woman is referred to her own physician.

 

Treatment

 

Each case is different and the most aggressive treatments are not always necessary. Sometimes breast-conserving surgery suffices. Sometimes only partial breast irradiation at the tumor-removal site is appropriate. Sometimes chemotherapy is not required. No one should delay or avoid seeing their physician because of assumptions about treatment.

 

Conclusion

 

In brief, breast cancer remains a major death threat to women. There are several types of breast cancer, each behaving with its own degree of aggressiveness. Screening is important since early breast cancers show minimal symptoms. Each woman is referred to her own physician regarding screening specifics. Since each case is different, the most aggressive treatments are not always necessary. No one should delay or avoid seeing a physician due to false assumptions about treatment.

 

 

References

 

U.S. Breast Cancer Statistics. (n.d.). Retrieved September 15, 2018, from https://www.breastcancer.org/symptoms/understand_bc/statistics

 

Breast Cancer: Practice Essentials, Background, Anatomy. (2018, July 18). Retrieved September 15, 2018, from https://emedicine.medscape.com/article/1947145-overview

 

 

Thomas Falasca, DO

Alzheimer Disease – the Memory Thief

Alzheimer Disease is the most common form of dementia.

 

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Alzheimer Disease – the Memory Thief

 

Alzheimer Disease– the Memory Thief

Alois Alzheimer

 

German psychiatrist and neurologist Alois Alzheimer received scant attention in 1906 when he published the case of a 51-year-old woman he had followed for five years until her death. The woman, he wrote, had trouble remembering her name, could not report what she was eating, could not write her husband’s name, and could not remember familiar objects after a few minutes. Alzheimer examined her brain after her death and presented the findings in this first reported case of Alzheimer Disease.

 

Prevalence

 

Alzheimer disease is the most common form of dementia. It affected over 6 million Americans in 2017. It was the sixth leading cause of death and produced an economic cost of $259 billion. Some studies suggest a higher incidence among women; however, some attribute this to women’s longer life expectancy. Medicare data suggest incidence of 11.5% among Hispanics, 9.4% among African-Americans, and 6.9% among Caucasians. Persons over 60 years of age constitute 90% of Alzheimer patients.

 

Causes

 

Physicians and scientists have no firm answers about the causes of Alzheimer, but do have some associations. As far back as 1906, Alois Alzheimer noted that the brain of his deceased patient contained irregularities known as amyloid plaques and neurofibrillary tangles. Although other aged people have these plaques and tangles, Alzheimer patients have them in increased

numbers and specific brain locations.

 

Risk Factors

 

Although science has not identified the causes of Alzheimer, it has identified certain risk factors. These are:

       Advancing age

       Family history

       Presence of certain genes

       Obesity

       Insulin resistance

       High blood pressure

       Down syndrome

       Traumatic brain injury

 

Symptoms

 

The symptoms of Alzheimer increase from the mild, through the moderate, and into the severe stages of the disease.

 

  • Mild stage symptoms include:
  •        Memory loss
  •        Confusion about location of familiar places
  •        Bad decisions
  •        Mood and personality changes

 

Moderate stage symptoms advance to:

  •        Short attention
  •        Difficulty recognizing friends and family
  •        Difficulty with language and numbers
  •        Inability to organize thoughts
  •        Difficulty coping with unexpected situations
  •        Loss of impulse control

 

Finally, severe stage symptoms culminate in:

  •        Weight loss
  •        Difficulty swallowing
  •        Lack of bowel and bladder control

 

Tests for Alzheimer

 

Currently, only autopsy or brain biopsy can make a definitive diagnosis of Alzheimer disease. Lumbar puncture, or spinal tap, can secure samples of spinal fluid for analysis; but this is helpful mostly in research. MRI and CT may be useful for ruling out other, potentially treatable diseases. Sometimes PET scanning helps to differentiate Alzheimer from other dementias.

 

Treatment

 

Available treatments for Alzheimer can only lessen the primary symptoms; they do not cure the disease or arrest its progress. Donepezil, rivastigmine, and galantamine are cholinesterase inhibitors. They work by slowing the breakdown of certain chemicals needed by nerve cells to function. Another drug, memantine, works by blocking brain cell absorption of a damaging chemical known as glutamate.

 

Other drugs simply alleviate secondary Alzheimer symptoms, such as depression, aggression, delusions, and sleep disorders.

 

Coping

    

Coping skills and strategies are central because Alzheimer is an incurable, progressive disease that extracts energy from both patient and caregivers.

Helpful coping tips are:

  •        Be realistic. Recognize that things will not be the same and that satisfactorymay take precedence over perfection.       
  •        Be clear, concise, and repetitious in communication.
  •        Use visual cues, such as gesturing, as well as verbal cues, in communication. 
  •        Reminisce about the past with photographs and videos.
  •        Be prepared to change, as measures that were effective at one stage may begin to fail as the disease progresses.

 

Conclusion

 

The conquest of Alzheimer disease will likely come slowly with progress on several fronts. These may consist of:

  •        Development of better coping strategies and education of caregivers in their use.
  •        Improved medications to lessen primary symptoms.
  •        Discovery of means to reduce the frequency of the disease.
  •        Development of methods to slow or arrest the progress of the disease.
  •        Invention of a biochemical cure for Alzheimer.
  •        Optimistically, but improbably, development of means to reverse damage done by the disease.

 

Success over Alzheimer will involve the mobilization of multiple resources, including, economic, sociological, political, educational, scientific, medical, and nursing. Moreover, it will involve the insightful proportioning of funds among these resources. Further, it will involve the proportioning of funds among many societal problems. In summary, the program against Alzheimer is far more than a medical commitment; it is a societal commitment.

 

Thomas Falasca, DO

Thomas Falasca, DO

 

References

 

Alzheimer Disease: Practice Essentials, Background, Anatomy. (2018, April 20). Retrieved from https://emedicine.medscape.com/article/1134817-overview

 

Coping Strategies for Alzheimer's Disease Caregivers. (n.d.). Retrieved from https://www.ucsfhealth.org/education/coping_strategies_for_alzheimers_disease_caregivers/

Back to School Health Tips

School days are upon us and that brings new concerns for our children’s health, concerns regarding backpacks, l ...See More


Back to School Health Tips

School days are upon us and that brings new concerns for our children’s health, concerns regarding backpacks, lunches, starting school, homework/study habits, and hygiene. Here are some helpful tips on how you can promote a healthier, happier school year.

 

Backpacks

  • Backpacks should have wide, padded shoulder straps and a padded back.
    The backpack should never weight more than 10-20% of the child’s weight.
    Both shoulder straps should be used so as not to produce uneven strain on either side of the back.
    Heavier items should be arranged close to the midline of the back.
    Do not ignore back pain in a child.
    If a child develops back pain that doesn’t improve, consider a second set of textbooks to keep at home.

 

Lunches

  • Consult school menus and consider packing a lunch on days when the menu includes items that your child doesn’t eat.
    Remember that a typical 12-ounce soft drink contains 10 teaspoons of sugar and 150 calories. Drinking just one can daily increases your child’s risk of obesity by 60%.

 

For Children Starting School

  • Answer any questions about school before classes begin.
    Introduce children to their school and, if possible, to their teacher, in advance.
    If possible, introduce them to classmates before the school year begins.
    Spend time talking with children about what happened in school.
    Make morning preparation as stress-free as possible by laying out books and clothes the night before.
    Let the child know that is normal to be a little anxious about starting school Assign a permanent workspace conducive to doing homework.

 

Homework and Study Habits

  • Schedule enough time for homework.
    Consider prohibiting TV and similar distractions during homework time.
    Supervise computer and internet use.
    Be available for consultation during homework time but do not do the child’s homework.

 

Hygiene

  • Stress hand washing before eating and after using the toilet,blowing the nose, tying the shoes, or playing outside.
    Handwashing should continue for as long as it takes to sing the “Happy Birthday Song” twice.
    Give the child an alcohol-based hand sanitizer to use whenever washing is unavailable and after using shared computers, pencil sharpeners, or other community objects.
    Remind the child to keep hands away from eyes and out of mouth.
    Stress the importance of not sharing food, water bottles, or other personal items.

 

So, with these tips in mind, the school year should bring peace of mind to the adults and new growth to the children.

 

Thomas Falasca, DO

 

 

For More Information Please Visit

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org/page.ww?name=Starting+School&section=Facts+for+Families

 

American Academy of Orthopedic Surgeons
http://orthoinfo.aaos.org/topic.cfm?topic=A00043

 

American Academy of Pediatrics: Back to School Tips http://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/pages/Back-to-School-Tips.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%253a+No+local+token

 

American Psychiatric Association
http://www.healthyminds.org/More-Info-For/Children/ABCs-of-Starting-School.aspx

 

Mayo Clinic
http://www.mayoclinic.com/health/childrens-conditions/CC00059/NSECTIONGROUP=2

Halloween Safety from American Academy of Pediatrics

 

Halloween is an e ...See More


Halloween Safety from American Academy of Pediatrics

 

ALL DRESSED UP:

  1. Plan costumes that are bright and reflective. Make sure that shoes fit well and that costumes are short enough to prevent tripping, entanglement or contact with flame.
  2. Consider adding reflective tape or striping to costumes and trick-or-treat bags for greater visibility.
  3. Because masks can limit or block eyesight, consider non-toxic makeup and decorative hats as safer alternatives. Hats should fit properly to prevent them from sliding over eyes. Makeup should be tested ahead of time on a small patch of skin to ensure there are no unpleasant surprises on the big day.
  4. When shopping for costumes, wigs and accessories look for and purchase those with a label clearly indicating they are flame resistant.
  5. If a sword, cane, or stick is a part of your child's costume, make sure it is not sharp or long. A child may be easily hurt by these accessories if he stumbles or trips.
  6. Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. While the packaging on decorative lenses will often make claims such as "one size fits all," or "no need to see an eye specialist," obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, and serious eye disorders and infections, which may lead to permanent vision loss.
  7. Review with children how to call 9-1-1 (or their local emergency number) if they ever have an emergency or become lost.

CARVING A NICHE: 

  1. Small children should never carve pumpkins. Children can draw a face with markers. Then parents can do the cutting.
  2. Consider using a flashlight or glow stick instead of a candle to light your pumpkin. If you do use a candle, a votive candle is safest. 
  3. Candlelit pumpkins should be placed on a sturdy table, away from curtains and other flammable objects, and not on a porch or any path where visitors may pass close by. They should never be left unattended.

HOME SAFE HOME:

  1. To keep homes safe for visiting trick-or-treaters, parents should remove from the porch and front yard anything a child could trip over such as garden hoses, toys, bikes and lawn decorations. 
  2. Parents should check outdoor lights and replace burned-out bulbs. 
  3. Wet leaves or snow should be swept from sidewalks and steps. 
  4. Restrain pets so they do not inadvertently jump on or bite a trick-or-treater. 

ON THE TRICK-OR-TREAT TRAIL:

  1. A parent or responsible adult should always accompany young children on their neighborhood rounds. 
  2. Obtain flashlights with fresh batteries for all children and their escorts.
  3. If your older children are going alone, plan and review the route that is acceptable to you. Agree on a specific time when they should return home.
  4. Only go to homes with a porch light on and never enter a home or car for a treat.
  5. Because pedestrian injuries are the most common injuries to children on Halloween, remind Trick-or-Treaters:
  6. Stay in a group and communicate where they will be going. 
  7. Remember reflective tape for costumes and trick-or-treat bags.
  8. Carry a cell phone for quick communication. 
  9. Remain on well-lit streets and always use the sidewalk. 
  10. If no sidewalk is available, walk at the far edge of the roadway facing traffic. 
  11. Never cut across yards or use alleys. 
  12. Only cross the street as a group in established crosswalks (as recognized by local custom). Never cross between parked cars or out driveways.
  13. Don't assume the right of way. Motorists may have trouble seeing Trick-or-Treaters. Just because one car stops, doesn't mean others will! 
  14. Law enforcement authorities should be notified immediately of any suspicious or unlawful activity.

HEALTHY HALLOWEEN:

  1. A good meal prior to parties and trick-or-treating will discourage youngsters from filling up on Halloween treats. 
  2. Consider purchasing non-food treats for those who visit your home, such as coloring books or pens and pencils.
  3. Wait until children are home to sort and check treats. Though tampering is rare, a responsible adult should closely examine all treats and throw away any spoiled, unwrapped or suspicious items. 
  4. Try to ration treats for the days and weeks following Halloween. 

©2017 American Academy of Pediatrics

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